Provider Demographics
NPI:1215138235
Name:MILRUSH, LLC
Entity type:Organization
Organization Name:MILRUSH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MILHORN
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-482-2249
Mailing Address - Street 1:503 CHESTER AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREAT FALLS
Mailing Address - State:SC
Mailing Address - Zip Code:29055
Mailing Address - Country:US
Mailing Address - Phone:803-482-2249
Mailing Address - Fax:803-482-3349
Practice Address - Street 1:503 CHESTER AVENUE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:SC
Practice Address - Zip Code:29055
Practice Address - Country:US
Practice Address - Phone:803-482-2249
Practice Address - Fax:803-482-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13459332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4108960001Medicare NSC